1. Field of the Invention
This invention generally relates to surgical apparatus and procedures and more specifically to a device and method for facilitating intracorporeal knot tying during endoscopic surgical procedures.
2. Description of Related Art
In endoscopic surgical procedures, all the techniques of dissection, cutting, suturing and knot tying must be performed with various elongated instruments that extend through trocars into a cavity of a patient. These instruments include needle holders, tissue graspers, introducers and related instruments for facilitating both extracorporeal and intracorporeal knot tying during endoscopic surgical procedures. Many of these systems utilize preformed loops to form ligatures or needle sutures. However, when preformed loops are used for ligatures, they can only be applied to tissue appendages. They can not, for example, be tied around ducts between two organs. Preformed loops also have a tendency to lock prematurely, that is, before the ligature is finally cinched in place. Extracorporeal knot tying can produce lost insufflation and requires extra time that can extend the overall time for completing a surgical procedure. Transferring a knot from the exterior of the body to the suture site is subject to premature cinching of the knot and the knots are subject to breakage when very thin sutures are used. Intracorporeal knot tying has been difficult to master and is also very time consuming.
The following patents disclose a number of apparatus that have been proposed for facilitating extracorporeal suture tying:
U.S. Pat. No. 3,580,256 (1971) Wilkinson PA1 U.S. Pat. No. 4,961,741 (1990) Hayhurst PA1 U.S. Pat. No. 4,957,498 (1990) Caspari et al PA1 U.S. Pat. No. 5,087,263 (1992) Li PA1 U.S. Pat. No. 5,098,137 (1992) Wardall PA1 U.S. Pat. No. 4,950,285 (1990) Wilk PA1 U.S. Pat. No. 5,100,418 (1992) Yoon et al PA1 U.S. Pat. No. 5,100,421 (1992) Christoudias
The Wilkinson patent discloses apparatus that supports a suture in an overlapping loop formation so one end of a suture can be threaded through the loop to form a throw and when pulled tight, a knot. However, in the Wilkinson patent the suture loop must be encased in wax prior to the surgical procedure and a separate casing or structure must be formed independently for each knot.
The Hayhurst patent discloses apparatus in which leading and trailing members guide a pair of suture knots, such as overhand knots, to a tissue surface. The first overhand knot is secured against the tissue as the second knot advances.
The Caspari et al patent disclose a suturing instrument that enables an extracorporeally tied knot to be moved into the body. The apparatus uses a throw stick to advance a knot to the tissue through a cannula.
The Li patent discloses a suture throw holder and rundown system. This apparatus includes a shaft with a cavity and longitudinal and radial slots for receiving a knot and extensions of a suture.
The Wardall patent discloses a structure for forming a knot, extracorporeally. It comprises a fork-like device with first and second tines.
The following patents disclose other proposals for suturing tissue:
The Wilk patent discloses a specially formed suture having at one end a preformed loop, a specially formed adjacent surface and a special capture structure.
The Yoon et al patent discloses a suture tie and applicator which holds preformed suture ties comprising rigid or semi-rigid segments of sutures disposed within and extending out of the distal end of a tubular locking member. The locking member displaces along the tie until it closes the open side of a tissue receiving area.
The Christoudias patent discloses a suture assembly that includes a needle holder, needle transporter and a needle suture.
None of the foregoing references disclose apparatus that enables or can be adapted to enable a surgeon to tie knots intracorporeally. Consequently a typical intracorporeal knot tying method involves wrapping one free end of a suture thread into a series of loops around a needle holder proximate a tissue site. Then the surgeon uses a grasping instrument to remove the loops from the needle holder without dropping a loop. Next the surgeon picks up the other free end of the suture thread through the loops. Finally the surgeon manipulates both ends of the suture tie to advance the resulting knot toward the tissue and to tighten the knot. Then, as this is a form of slip knot, the procedure is repeated.
As will be apparent, this process is time consuming and complex. It requires great dexterity by the surgeon and is difficult to master. Various instruments must be withdrawn after the suture has passed through the tissue and this further complicates the procedure. Moreover, each time an instrument is replaced, any gas being used in conjunction with the procedure can escape through an open trocar. Notwithstanding these problems, surgeons continue to use either of these extracorporeal or intracorporeal knot tying procedures.